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FCI Application Form

23/07/13 9:13 PM

ZONE-WISE RECRUITMENT FOR MANAGEMENT TRAINEE (GENERAL/ DEPOT/ MOVEMENT/ ACCOUNTS/ TECHNICAL/ CIVIL ENGINEERING/ MECHANICAL ENGINEERING/ ELECTRICAL ENGINEERING) Application Form for the Post of : MANAGEMENT TRAINEE (GENERAL), MANAGEMENT TRAINEE (DEPOT), MANAGEMENT TRAINEE (MOVEMENT),

NORTH ZONE
Registration No. : 229400
1.Candidate's Name 2.Father's Name 3.Gender 4.Date of Birth 5.Age(as on 01.08.2013) 6.Category 7.Whether Domiciled in the Kashmir Division in the State of J & K during the period 0101-1980 to 31-12-1989 (Enclose relevant certificate) 8.Whether Ex-Serviceman 9.Whether Person with Disabilities(PWD)/Physically Handicapped(PH) 10.Whether Departmental (FCI) Employee 11.Whether belonging to Minority Community : NO 13.Zone Applied For 14.Name of the Written Test Center 15.Preference of Post Code Applied for : 16.Educational Qualification: Percentage of marks up to 2 decimal Duration of points in Remrarks,if the Course / aggregate any Programme of all years/semesters : : : NORTH JAIPUR Preference 1 Preference 2 Preference 3 Preference 4 B C A : ANUJ SADH : SOHAN LAL SADH : MALE : 13/09/1986 (supporting Document to be enclosed)

: 26 YEARS ,10 MONTHS ,18 DAYS : : :


: :

GENERAL NO NO NO NO 12.Nationality :INDIAN

Post Code

Post Code (s) Applied For

Name of Academic/ Professional Degree/Diploma(which makes you eligible)

Discipline

Name of the University / Borad

Year of Passing

A and/or B and/or C D or E or F or G or H
18.Email ID

A BC

GRADUATE DEGREE OR EQUIVALENT B.E. -

ECE

RAJASTHAN UNIVERSITY -

2008

48

65.66

: : : : YES

17.Whether Completed

SADH.ANUJ21@YAHOO.CO.IN 8290877075 YES (30 Months)

19.Mobile Number 20.Experience: 21.Communication Address City State 22. Whether Fee Paid : YES 23.Mode of Payment DD No.

: D-1, BHERU VILAS COLONY, NEAR K.V. NO. 1 AIR FORCE, RATANADA : JODHPUR : RAJASTHAN District Pin Code : : JODHPUR 342011

: DEMAND DRAFT : 1364 Date of Issue : 23/07/2013

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FCI Application Form

23/07/13 9:13 PM

Name of Bank & Branch Branch Code

: AXIS BANK LTD. JALORE : 1287 Amount : 500

24.Declaration : 1. I have not submitted any other application for this examination. I am aware that if I contravene this rule, my application will be rejected summarily by FCI. 2. I have read the provisions in the Advertisement carefully and hereby undertake to abide by them. 3. I further declare that I fulfill all the conditions of eligibility regarding age limits, educational qualifications, experience etc. prescribed for the post applied for. 4. I also declare that I do not stand debarred by FCI as on date and have never been convicted by any court of law. I also declare that no charge sheet is pending against me in any court of law.Further declare that I have never been dismissed or compulsorily retired from the service of the Corporation or from a Department of a State or the Central Government or from any Public Sector Undertaking. 5. For Candidate belonging to OBC. I declare that I belong to the community, which is recognized as backward class by the Govt. of India for the purpose of reservation in services as per order contained in Deptt. of Personnel and Training Office Memorandum No. 36012/22/93-Estt.(SCT)dated 8.9.1993. I also declare that I do not belong to the person/sections (creamy layer) mentioned in column 3 of the schedule of the OM mentioned above and modified vide Govt. of India DOPT OMs mentioned in the Notice. I further declare that I am in possession of OBC Certificate in the prescribed format given in the Notice of the Advertisement. 6. I hereby declare that all the statements made by me in the application are true, complete and correct to the best of my knowledge and belief and nothing has been concealed or suppressed. In the event of any information being found false or incorrect at any point of time my candidature / appointment may be cancelled / terminated without any notice and/or I shall be liable for any other action under the extant rules. Date: Place: Signature: Candidate's Name (in Capital letters): 25.CERTIFICATE FROM THE PRESENT EMPLOYER (For candidates serving in Central/State Government ,Public Sector Undertakings,and Autonomous Bodies) Certified that the above mentioned information furnished by the Appplicant is true and there is no Vigilance/Disciplinary case pending against him/her. We have no objection to his/her applying for the above post in FCI and if selected, he/she shall be relieved as per this Organisation's norms subject to his/her compliance of all terms and conditions of the Service Rules.

(Signature & Seal of Employer) 26 . Checklist: Self-certified copies of relevant certificates/documents to be enclosed with Application Form. I hereby cerify that the self-cerified copies of following certificates/documents are enclosed along with the duly completed online Application Form.In Case ,self-certified copies of the relevant certificates/documents are not enclosed with the online Application form ,my candidature/appointment may be cancelled/terminated without any notice. Bank Challan(3rd Copy-FCI Copy)/Demand Draft(on the back side of DD Name,DOB,Zone & Post applied for is indicated.) Date of Birth Certificate(as recorded in the Matriculation/Secondary Examination Certificate). Degree/Provisional Certificate of Degree/Diploma of Essential Qualification. Marksheet of Degree/Diploma. Caste(OBC/SC/ST)Certificate,if applicable. PWD/PH Certificate,if applicable. Experience Certificate,if applicable. No objection Certificate,if applicable. Ex-Serviceman Certificate, if applicable. Date: Place: Signature: Candidate's Name (in Capital letters):

(Please Print the form for Further Reference)

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